Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers, Version 5.0
Children’s Oncology Group. (2018).
Monrovia (CA): Children’s Oncology Group, (Version 5.0), Retrieved September 27, 2019 from www.survivorshipguidelines.org.
This guideline provides recommendations about therapeutic cancer interventions and their potential late effects and screening referrals for conditions or exposures as a result of pediatric cancer. This guideline includes recommendations relevant to audiology and speech-language pathology services following chemotherapy, radiology, or neurosurgery.
Children's Oncology Group
<p>This guideline was reviewed with the following:</p><ul><li>Landier, W., Bhatia, S., et al. (2004). Development of Risk-Based Guidelines for Pediatric Cancer Survivors: The Children's Oncology Group Long-Term Follow-up Guidelines from the Children's Oncology Group Late Effects Committee and Nursing Discipline. <em>Journal of Clinical Oncology, 22</em>(24), 4979-4990. doi:10.1200/JCO.2004.11.032</li></ul>
<div>Children who have received chemotherapy with exposure to heavy metals may experience later ototoxic effects. Consider speech and language therapy for patients with hearing loss (Score 1).</div>
<div>For children, adolescents, and young adults who received chemotherapy or radiation (doses of ≥30 Gy) treatment for cancer, considerations for intervention include:</div>
<ul>
<li>"audiology consultation for any survivor who has symptoms suggestive of hearing loss, tinnitus, or abnormal pure tone audiometry results showing a loss of more than 15 dB absolute threshold level (1000-8000 Hz)" (Score 1; p. 26, 78);</li>
<li>"ongoing follow-up with audiology for patients with hearing loss" (Score 1; p. 26, 78);</li>
<li>providing "specialized evaluation for specific needs and/or preferential classroom seating, FM amplification, and other educational assistance as indicated" (Score 1; p. 26, 78).</li>
</ul>
<div>For children 6-12 years of age who received chemotherapy or radiation (doses of ≥30 Gy) treatment for cancer, pure tone audiometry (PTA) testing at 1000-8000 Hz should be completed every 2 years. At 13 years and older, patients should have PTA at 1000-8000 Hz every 5 years. All individuals who underwent cancer treatment should receive annual otoscopic evaluation (Score 1). "Additional testing with high frequency audiometry at >8000 Hz is recommended if equipment is available" (Score 1; p. 26, 78). "Frequency-specific auditory brainstem response (ABR) can be performed if the above is inconclusive" (Score 1; p. 26, 78). "Consider patient and cancer/treatment factors, pre-morbid/co-morbid health conditions, and health behaviors, as appropriate, that may increase risk" (Score 1; p. 26, 78).</div>
<div>For children, adolescents, and young adults who received chemotherapy or radiation (doses of ≥30 Gy) treatment for cancer, "refer patients with auditory deficits to school liaison in community or cancer center (psychologist, social worker, school counselor) to facilitate acquisition of educational resources" (Score 1; p. 26, 78).</div>
<div>For children less than 5 years of age who received chemotherapy or radiation (doses of ≥30 Gy) treatment for cancer, complete audiological evaluation should be completed by an audiologist annually. "Consider patient and cancer/treatment factors, pre-morbid/co-morbid health conditions, and health behaviors, as appropriate, that may increase risk" (Score 1; p. 26, 78). Testing for both ears includes:</div>
<ul>
<li>an otoscopic exam;</li>
<li>pure tone air and bone conduction;</li>
<li>speech audiometry;</li>
<li>tympanometry; and</li>
<li>high-frequency audiometry at >8000 Hz, if equipment is available (Score 1).</li>
</ul>
<div>"Frequency-specific auditory brainstem response (ABR) can be performed if the above is inconclusive" (Score 1; p. 26, 78).</div>
<div>The following considerations were recommended for children who have received chemotherapy, radiation therapy, or neurosurgery, with potential neurocognitive deficits (Score 1, Score 2A):</div>
<ul>
<li>Refer for a formal neuropsychological evaluation, which may include standardized assessment of processing speed, computer-based attention, visual motor integration, memory, comprehension of verbal instructions, verbal fluency, executive function and planning.</li>
<li>Conduct an evaluation at the beginning of long-term follow-up, then periodically if patients begin to show signs of impaired educational or vocational progress.</li>
<li>refer to a school liaison in the community or cancer center to help acquire educational resources and/or social skills training.</li>
</ul>
<div> </div>
<div>Consider speech, physical, and occupational therapy for patients with persistent motor and/or sensory deficits following neurosurgery in cases of pediatric brain tumors (Score 1).</div>
